Why Belong to the Lake Health IPHE/PHO?
The Lake Health Integrated Physician Hospital Enterprise (IPHE) is the clinical integration program for the Lake Health Physician Hospital Organization (PHO), which is a 50/50 joint venture between 300+ community- based physicians and Lake Health facilities. The Lake Health PHO also offers physician members the opportunity to participate in the Lake Health IPHE. The primary function of the IPHE is to operate a Clinical Integration Program on behalf of PHO. The IPHE is a physician-led, physician-driven effort that combines the latest in evidence-based best practices with innovative data collection technology in a way that aligns physicians’ economic incentives and drives improvement in clinical quality. The IPHE clinically integrates the physician members through the agreement to follow physician developed clinical initiatives designed to achieve “likely improvements” in quality and efficiency. The IPHE is focused on achieving true clinical excellence, while providing all members the ability to collectively negotiate fee-for-service and clinically driven incentive third-party payer agreements in a legal, effective, and forthright manner. The IPHE Board of Managers consists of 15 member; 10 physicians and 5 administrators. Multiple physician led committees are operational within the IPHE. Those committees include: Quality, Ambulatory Quality, Utilization/Compliance/ Finance and Payor Relations/ Credentials/ Information Technology among many others.
Lake Health IPHE Vision
The Lake Health IPHE members shall develop, implement, and maintain a clinical integration program in order to better serve the health care needs of the communities served. The IPHE commits to the creation and maintenance of active and ongoing clinical initiatives to evaluate and modify the practice patterns of, and create a high degree of interdependence and cooperation between participating physicians including: (a) collaboration with the independent and employed physicians in the identification of quality improvement, efficiency, and cost effectiveness initiatives for the CI Program; (b) secure and maintain required technology infrastructure and human capital to support the CI Program; (c) design and deploy the quality-based membership criteria, clinical initiatives, financial incentives, and remediation procedures of the program; and, (d) develop physician education activities designed to orient physicians to the CI /ACO program; while engaging in contracting activities for the entire network focused to effectively accommodate new and innovative programs and arrangements for healthcare payment and delivery.
Lake Health IPHE Objectives
- Physicians will collaborate with each other and Lake Health to simultaneously improve the quality and reduce the cost of care under employer-sponsored and government health care benefit plans.
- Our Clinical Integration Program is structured to position Lake Health and the IPHE member providers:
- Reward value NOT volume (Value based purchasing)
- Practice Evidence Based Care
- Focus on Reducing Hospital Readmissions
- Provide Transparency in Cost and Quality
- Accept alternate risk-based reimbursement models (end of Fee for Service)
- Quality and Utilization Management Committees assume significant roles in data collection and evaluation.
- Evidence based successes will be rewarded.
- Practice patterns with consistently poor outcomes will be identified and remediated.
The following are the participation criteria and standards agreed to by all members:
- Joint contracting and participation in CI contracts. The Lake Health IPHE will involve true collective negotiations with commercial health plans, including quality-enhanced fee schedules, shared savings bonuses, and pay-for-performance incentives. As such, participation in the Lake Health IPHE requires all members to participate in all of these clinically-integrated health plan contracts, members do not have the ability to opt out of these health plan agreements and still remain in the Lake IPHE.
- Compliance with CI Program initiatives. In order to participate in these collectively-negotiated contracts, all members are required to: (1) perform clinically at benchmarks established by the Lake Health IPHE Quality Committee and approved by the Lake Health IPHE Board of Managers, (2) attend special education sessions and round-table discussions, and (3) adopt more efficient clinical practices and administrative technologies.
- Agreement to share practice data re. patient care. Measuring performance in the Lake IPHE Clinical Integration Program requires each practice to track quality performance measures using special billing codes (e.g., Category II CPT Codes) and to provide Lake Health IPHE with claims data generated by your practice management system that contain these codes through linking to the Crimson Clinical Care program. Lake Health IPHE maintains all claims data and individual results acquired as part of this program confidential, and does not share practice specific information with health plans or third party payors.
- Accountability through incentive, remediation, and disciplinary measures. Fundamental to the Lake Health IPHE program are enforcement mechanisms, whereby physicians are held accountable for their performance, both individually and as a group. Lake Health IPHE will maintain such accountability with regard to each participating member by means of economic rewards, peer-to-peer counseling, and corrective action plans. If these positive efforts have no effect on the physician’s performance, Lake Health IPHE may also pursue disciplinary action – up to and including removing the member from participating in the Lake Health IPHE Clinical Integration Program and its collectively-negotiated health plan contracts.
Benefits of Membership:
Managed Care Contracting - The IPHE/PHO has provider contracts with approximately twenty (20) managed care companies. Managed Care companies have repeatedly demonstrated the value of group negotiations via increased compensation levels and language modifications that are unavailable in direct individual negotiations.
Re-Negotiations - Additionally to successful initial negotiations, the IPHE/PHO actively monitors and requests renegotiations of it’s managed care agreements.
Managed Care Services - Our staff has the expertise and resources to assist you with payment and patient complaints. Often you may feel that the managed care companies have little concern for your overall satisfaction or addressing your specific issues. Because of the IPHE/PHO relationships with the leadership of the managed care companies, the IPHE/PHO often provides resolution to issues that you have not been able to resolve.
Centralized Credentialing - The IPHE/PHO has been delegated as the credentialing entity for approximately eighteen (18) contracted managed care companies. This single credentialing process eliminates your office's need to complete repeated application and repeated interruption from multiple site visits.
Electronic Health Records - eClinicalWorks (eCW) is the vendor of choice for IPHE/PHO members. This unified software package includes electronic health records, practice management and billing software. As a result of Lake Health's financial contribution toward the purchase of the eCW, this software is affordable even for the small office.
Medical Community Sounding Board - The IPHE/PHO routinely provides its membership with current up to date bulletins ("Blast Facts") regarding emerging topics within the physician offices. Topics include new payor contracting initiatives, policy changes affecting reimbursements, trends/complaints registered at other local practices.
Physician Directory - This directory is distributed at community events and to local employers in Lake and neighboring counties.